Comparative analysis of clinical and radiological presentation, histological findings and operative outcome of brainstem tumors

Gliomi moždanog stabla čine manje od 2% tumora mozga odraslih. Terapeutske opcije su limitirane i one su udružene sa visokom stopom morbiditeta i mortaliteta. Materijal i metod. Prikazujemo seriju od 51 pacijenta hospitalizovanog u Klinici za neurohirurgiju Kliničkog centra Srbije u periodu od 1998 do 2012 godine. Beležili smo demografske i kliničke varijable, kao i histopatološki nalaz i klinički ishod. Rezultati. Od 51 pacijenta 62,7% su bila muškog pola, a 37,3% ženskog pola, prosečne starosti 30,6±19,3 godina. U uzrastu 38.2±17.9 godina dominira visokogradusni tip glioma (As. gr. III i IV) – t=2.481, p=0.017. Dok histološki tip As. gr. I-II dominantan u mlađem uzrastu 25.4±17.4 godina - X2=4.013; p=0.045, sa lokalizacijom u ponsu - X2=5.299; p=0.021 i prisutnom egzofitičnom komponentom - X2=3.862; p=0.049. Ataksija kao inicijalni simptom je prediktor lošeg ishoda - HR 5.546; p=0.012. Zaključak. Zbog specifične lokalizacije gliomi moždanog stabla (GMS) zbog svoje lokalizacije i danas predstavljaju veliki izazov za neurohiruge, zbog potrebe identifikacije bezbednog pristupa i mogućnosti što radikalnije resekcije. Histološka verifikacija GMS određuje potrebu za dodatnim terapijskim procedurama – zračenje i hemioterapija. Benefit od korektne dijagnoze ogleda se u izbegavanju potencijalno neželjenih terapijskih efekata.Brain stem gliomas constitute less than 2% of brain tumors in adults. Therapeutic options are limited and brainstem gliomas are associated with a high morbidity and mortality. Materials and methods. We reviewed the records of 51 patients with brainstem gliomas treated at the Institute of Neurosurgery, Clinical Center of Serbia in Belgrade between 1998 and 2012. We recorded demographic and clinical variables as well as radiological findings and survival. Results. Of the 51 patients 62.7% were male and 37.3% female, mean age 30.6 ± 19.3 years. At the age 38.2 ± 17.9 years dominated the high grade type of glioma (As. Gr. III and IV) - t = 2.481, p = 0.017. While histological type As. gr. I-II dominant in the younger age 25.4 ± 17.4 years - X2 = 4.013; p = 0.045, with localization in the pons - X2 = 5.299; p = 0.021 and present exophytic component - X2 = 3.862; p = 0.049. Ataxia as initial symptom is a predictor of poor outcome - HR 5.546; p = 0.012. Conclusion. Due to its specific localization brain stem gliomas (BSG) today present a major challenge for neurosurgery, because of need for safe approach due to radical resection. Histological verification BSG determines the need for additional therapeutic procedures - radiation and chemotherapy. Benefit from correct diagnosis is reflected in the avoidance of potentially adverse effects of treatment

Multiformni glioblastom lokaliziran u motornom korteksu: specifičnosti u odnosu na gliome niskog stupnja iste lokalizacije - analiza serije od šezdeset bolesnika

The verified presence of a glioblastoma multiforme (GBM ) tumor in the motor area of the brain, in a patient lacking preoperative neurological deficit, offers no certainty that the tumor can be radically removed without the possibility of causing postoperative motor deficit. We present a series of 60 patients hospitalized at the Clinical Department of Neurosurgery, Clinical Center of Serbia in Belgrade between October 2011 and February 2015, harboring tumors located within and in the vicinity of the motor zone of the brain. By using Karnofsky‘s index (KI), the pre- and postoperative conditions of the patients were evaluated. Regarding electrical stimulation of the motor cortex, significantly lower values of the electrical current intensity, frequency, and pulse wave duration (p<0.01) were needed for triggering motor response in case of GBM tumor compared to a slowly growing tumor (low-grade). Patients with low-grade gliomas (LGG) had statistically significantly higher KI values pre- and postoperatively than patients with GBM (p<0.01). Using electrical stimulation of the cortex, a higher grade of resection of LGG could be achieved as compared with the group presenting with GBM (c2=5.281; df=1; p<0.05). Our findings and review of the results reported by other authors underline the necessity of routine application of electrical stimulation of the cerebral cortex in order to identify the primary motor field (M1).Jasna prezentacija tumora mozga u području motorne zone kod bolesnika koji prijeoperacijski nisu imali slabost ekstremiteta nije jamstvo da se on može radikalno odstraniti bez poslijeoperacijskog neurološkog deficita. Prikazujemo niz od 60 ispitanika sa supratentorijalnim tumorima lokaliziranim u i oko motorne zone mozga, koji su hospitalizirani na Institutu za neurokirurgiju KCS u Beogradu u razdoblju od listopada 2011. do veljače 2015. godine. Procjena prije- i poslijeoperacijskog stanja bolesnika je vrednovana ljestvicom Karnofski indeksa (KI). Iz serije su isključeni bolesnici s recidivom tumora i bolesnici čiji je KI kod prijma bio manji od 70. Tijekom procedure elektrostimulacije motornog korteksa potrebne su značajno manje vrijednosti jačine struje, frekvencije i pulsnog vala (p<0,01) za izazivanje motornog odgovora u slučaju postojanja tipa tumora multiformnog glioblastoma (glioblastoma multiforme, GBM ) u odnosu na spororastuće gliome (niskog stupnja) mozga. Nađena je statistički značajna razlika u prije- i poslijeoperacijskim vrijednostima KI (F=48,856; df=1; p<0,01; Eta2=0,457), naime, bolesnici s gliomima niskog stupnja imali su statistički značajno veću vrijednost KI prije- i poslijeoperacijski u odnosu na vrijednosti KI kod skupine bolesnika s GBM (p<0,01). Uporabom elektrostimulacije korteksa postignut je veći stupanj radikalnosti kirurške resekcije glioma niskog stupnja u odnosu na skupinu bolesnika s GBM (c2=5,281; df=1; p<0,05). Kirurgija tumora lokaliziranih u motornom korteksu predstavlja izazov zbog pratećeg rizika od de novo nastanka motornog deficita. Naši rezultati kao i rezultati drugih autora pokazuju neophodnost rutinske primjene direktne elektrostimulacije moždane kore radi identifikacije primarnog motornog polja (M1)

Određivanje prediktivnih anatomskih parametara za krvarenje arteriovenskih malformacija mozga pomoću multidetektorske CT angiografije

Patients with brain arteriovenous malformation (AVM) have a certain risk to bleed, and the goal of this study was to examine the effect of radiological and clinical predictive characteristics of AVM hemorrhage using multidetector computed tomographic (MDCT) angiography. The study included a series of 57 patients, mean age 35.46 years, who were diagnosed during their hospitalization at Clinical Department of Neurosurgery, Clinical Center of Serbia, in the period from January 2008 to March 2016. In all patients, the diagnosis was made using MDCT angiography. Two groups of patients were observed. The first group included patients who did not initially present with hemorrhage, while the second group initially presented with hemorrhage. Both groups were treated with medical therapy or a combination of medical therapy with embolization/surgery/radiotherapy. Deep venous drainage (p60 mm, venous dilatation present in the drainage vein (p60 mm, the angle of the casting feeding arteries in the nidus ≥130° and dilatation and/or venous aneurysm of drainage vessel are predictive for clinical presenting by hemorrhage.Bolesnici s arteriovenskim malformacijama mozga (AVM) imaju određen rizik za krvarenje pa je cilj ove studije bio ­ispitati utjecaj radioloških i kliničkih prediktivnih karakteristika AVM za hemoragiju pomoću multidetektorske CT angiog-rafije (MDCTA). U studiju je bilo uključeno 57 bolesnika srednje dobi od 35,46 godina kojima je dijagnoza postavljena na Institutu za radiologiju i magnetskom rezonancijom dok su bili hospitalizirani na Klinici za neurologiju Kliničkog centra Srbije u razdoblju od siječnja 2008. do ožujka 2016. godine. Svim bolesnicima je dijagnoza postavljena pomoću MDCTA. Praćene su dvije skupine bolesnika. Jednu skupinu činili su bolesnici kod kojih se AVM u početku nije manifestirala krva-renjem, dok se druga skupina odmah prezentirala hemoragijom. Obje skupine su liječene medikamentnom terapijom ili kombinacijom medikamentne terapije s embolizacijom/kirurškom intervencijom/radioterapijom. Duboka venska drenaža (p60 mm, prisutna venska dilatacija na dre-nažnoj veni (p60 mm, kutom ulijevanja dovodne arterije u nidus ≥130° i dilatacijom i/ili aneurizmom drenažne vene su prediktivni model za kliničko prezentiranje hemoragijom

Assessing the quality of angiographic display of brain blood vessels aneurysms compared to intraoperative state

Background/Aim. Aneurysms in brain blood vessels are expanding bags composed of a neck, body and fundus. Clear visibility of the neck, the position of the aneurysm and surrounding structures are necessary for a proper choice of methods for excluding the aneurysm from the circulation. The aim of this study was to evaluate the reliability of spatial reconstruction of blood vessels of the brain based on the original software for 3D reconstruction of the equipment manufacturer and a personal computer model developed earlier in the Clinic for Neurosurgery, Clinical Center of Serbia, Belgrade, compared to intraoperative identification of these aneurysms. Methods. This study included 137 patients of both sexes. The presence of an aneurysm was verified by angiographic methods [computed tomographic angiography (CTA), multislice computed tomography angiography (MSCTA), magnetic resonance imaging angiography (MRA), or digital subtraction angiography (DSA)]. Results. The quality score (0 to 5) for CTA was 3.180 ± 0.961, MSCTA 4.062 ± 0.928, and for DSA 4.588 ± 0.758 (p < 0.01). The results of this study favorite conventional angiography as the gold standard for diagnostic of intracranial aneurysms. Conclusion. The results of this study are consistent with current publications review and clearly recognize the advantages and disadvantages of diagnostic neuroradiological procedures, with DSA of brain blood vessels as a binding preoperative diagnostic procedure in cases in who it is not possible to clearly visualize the supporting blood vessel and neck of the aneurysm by using the findings of CTA, MRA and MSCTA

Vrijednost multidetektorske kompjutorizirane tomografije orbita u određivanju stupnja protruzije bulbusa u usporedbi s Hertelovom egzoftalmometrijom

The use of multidetector computed tomography (MDCT) is an integral part of contemporary diagnostics of Graves‘ orbitopathy. Th e aim of this study was to assess proptosis measurement by MDCT and to compare it to the current standard, Hertel exophthalmometry. A crosssectional study was conducted at the Clinical Centre of Serbia and included 91 patients (19 male and 72 female) with verified Graves‘ orbitopathy. Globe protrusion measured by MDCT (globe protrusion, GPR) was correlated to Hertel measured protrusion (HR). Th ere was no constant or any systematic bias between the two methods. GPR significantly correlated with the best-corrected visual acuity, while HR did not. Age, body mass index and duration of the disease did not influence proptosis measurement by either method. Proptosis was significantly larger in males. According to our results, GPR compared to HR provides better assessment of the protrusion in Graves‘ disease. GPR measurement is simple and should always be part of the radiological assessment of orbits in Graves‘ disease.Korištenje multidetektorske kompjutorizirane tomografije (MDCT) je sastavni dio suvremene dijagnostike Gravesove orbitopatije. Cilj ovoga istraživanja bio je ispitati mjerenje stupnja protruzije bulbusa pomoću MDCT i to usporediti s trenutnim standardom, Hertelovom egzoftalmometrijom. Presječno istraživanje je provedeno na Kliničkom centru Srbije, a uključilo je 91 bolesnika (19 muškaraca i 72 žene) s provjerenom Gravesovom orbitopatijom. Stupanj protruzije bulbusa mjeren pomoću MDCT (globe protrusion, GPR) je povezan s izmjerenim stupnjem protruzije bulbusa prema Hertelu (HR). Nije bilo stalne ili sustavne pristranosti između dviju metoda. GPR je bio značajno povezan s najbolje korigiranom oštrinom vida, a HR nije. Dob, indeks tjelesne mase i trajanje bolesti ne utječu na mjerenje stupnja protruzije bulbusa bilo kojim postupkom. Stupanj protruzije bulbusa bio je značajno veći u muškaraca. Prema našim rezultatima, GPR u odnosu na HR omogućuje bolju procjenu stupnja protruzije bulbusa kod Gravesove orbitopatije. Mjerenje GPR je jednostavno i treba uvijek biti dio radiološke procjene orbite kod Gravesove orbitopatije

Comparative analysis of clinical and radiological presentation, histological findings and operative outcome of brainstem tumors

Gliomi moždanog stabla čine manje od 2% tumora mozga odraslih. Terapeutske opcije su limitirane i one su udružene sa visokom stopom morbiditeta i mortaliteta. Materijal i metod. Prikazujemo seriju od 51 pacijenta hospitalizovanog u Klinici za neurohirurgiju Kliničkog centra Srbije u periodu od 1998 do 2012 godine. Beležili smo demografske i kliničke varijable, kao i histopatološki nalaz i klinički ishod. Rezultati. Od 51 pacijenta 62,7% su bila muškog pola, a 37,3% ženskog pola, prosečne starosti 30,6±19,3 godina. U uzrastu 38.2±17.9 godina dominira visokogradusni tip glioma (As. gr. III i IV) – t=2.481, p=0.017. Dok histološki tip As. gr. I-II dominantan u mlađem uzrastu 25.4±17.4 godina - X2=4.013; p=0.045, sa lokalizacijom u ponsu - X2=5.299; p=0.021 i prisutnom egzofitičnom komponentom - X2=3.862; p=0.049. Ataksija kao inicijalni simptom je prediktor lošeg ishoda - HR 5.546; p=0.012. Zaključak. Zbog specifične lokalizacije gliomi moždanog stabla (GMS) zbog svoje lokalizacije i danas predstavljaju veliki izazov za neurohiruge, zbog potrebe identifikacije bezbednog pristupa i mogućnosti što radikalnije resekcije. Histološka verifikacija GMS određuje potrebu za dodatnim terapijskim procedurama – zračenje i hemioterapija. Benefit od korektne dijagnoze ogleda se u izbegavanju potencijalno neželjenih terapijskih efekata.Brain stem gliomas constitute less than 2% of brain tumors in adults. Therapeutic options are limited and brainstem gliomas are associated with a high morbidity and mortality. Materials and methods. We reviewed the records of 51 patients with brainstem gliomas treated at the Institute of Neurosurgery, Clinical Center of Serbia in Belgrade between 1998 and 2012. We recorded demographic and clinical variables as well as radiological findings and survival. Results. Of the 51 patients 62.7% were male and 37.3% female, mean age 30.6 ± 19.3 years. At the age 38.2 ± 17.9 years dominated the high grade type of glioma (As. Gr. III and IV) - t = 2.481, p = 0.017. While histological type As. gr. I-II dominant in the younger age 25.4 ± 17.4 years - X2 = 4.013; p = 0.045, with localization in the pons - X2 = 5.299; p = 0.021 and present exophytic component - X2 = 3.862; p = 0.049. Ataxia as initial symptom is a predictor of poor outcome - HR 5.546; p = 0.012. Conclusion. Due to its specific localization brain stem gliomas (BSG) today present a major challenge for neurosurgery, because of need for safe approach due to radical resection. Histological verification BSG determines the need for additional therapeutic procedures - radiation and chemotherapy. Benefit from correct diagnosis is reflected in the avoidance of potentially adverse effects of treatment

Comparative analysis of clinical and radiological presentation, histological findings and operative outcome of brainstem tumors

Gliomi moždanog stabla čine manje od 2% tumora mozga odraslih. Terapeutske opcije su limitirane i one su udružene sa visokom stopom morbiditeta i mortaliteta. Materijal i metod. Prikazujemo seriju od 51 pacijenta hospitalizovanog u Klinici za neurohirurgiju Kliničkog centra Srbije u periodu od 1998 do 2012 godine. Beležili smo demografske i kliničke varijable, kao i histopatološki nalaz i klinički ishod. Rezultati. Od 51 pacijenta 62,7% su bila muškog pola, a 37,3% ženskog pola, prosečne starosti 30,6±19,3 godina. U uzrastu 38.2±17.9 godina dominira visokogradusni tip glioma (As. gr. III i IV) – t=2.481, p=0.017. Dok histološki tip As. gr. I-II dominantan u mlađem uzrastu 25.4±17.4 godina - X2=4.013; p=0.045, sa lokalizacijom u ponsu - X2=5.299; p=0.021 i prisutnom egzofitičnom komponentom - X2=3.862; p=0.049. Ataksija kao inicijalni simptom je prediktor lošeg ishoda - HR 5.546; p=0.012. Zaključak. Zbog specifične lokalizacije gliomi moždanog stabla (GMS) zbog svoje lokalizacije i danas predstavljaju veliki izazov za neurohiruge, zbog potrebe identifikacije bezbednog pristupa i mogućnosti što radikalnije resekcije. Histološka verifikacija GMS određuje potrebu za dodatnim terapijskim procedurama – zračenje i hemioterapija. Benefit od korektne dijagnoze ogleda se u izbegavanju potencijalno neželjenih terapijskih efekata.Brain stem gliomas constitute less than 2% of brain tumors in adults. Therapeutic options are limited and brainstem gliomas are associated with a high morbidity and mortality. Materials and methods. We reviewed the records of 51 patients with brainstem gliomas treated at the Institute of Neurosurgery, Clinical Center of Serbia in Belgrade between 1998 and 2012. We recorded demographic and clinical variables as well as radiological findings and survival. Results. Of the 51 patients 62.7% were male and 37.3% female, mean age 30.6 ± 19.3 years. At the age 38.2 ± 17.9 years dominated the high grade type of glioma (As. Gr. III and IV) - t = 2.481, p = 0.017. While histological type As. gr. I-II dominant in the younger age 25.4 ± 17.4 years - X2 = 4.013; p = 0.045, with localization in the pons - X2 = 5.299; p = 0.021 and present exophytic component - X2 = 3.862; p = 0.049. Ataxia as initial symptom is a predictor of poor outcome - HR 5.546; p = 0.012. Conclusion. Due to its specific localization brain stem gliomas (BSG) today present a major challenge for neurosurgery, because of need for safe approach due to radical resection. Histological verification BSG determines the need for additional therapeutic procedures - radiation and chemotherapy. Benefit from correct diagnosis is reflected in the avoidance of potentially adverse effects of treatment

Determination of Predictive Anatomic Parameters for Bleeding of Brain Arteriovenous Malformations by Multidetector CT Angiography

Patients with brain arteriovenous malformation (AVM) have a certain risk to bleed, and the goal of this study was to examine the effect of radiological and clinical predictive characteristics of AVM hemorrhage using multidetector computed tomographic (MDCT) angiography. The study included a series of 57 patients, mean age 35.46 years, who were diagnosed during their hospitalization at Clinical Department of Neurosurgery, Clinical Center of Serbia, in the period from January 2008 to March 2016. In all patients, the diagnosis was made using MDCT angiography. Two groups of patients were observed. The first group included patients who did not initially present with hemorrhage, while the second group initially presented with hemorrhage. Both groups were treated with medical therapy or a combination of medical therapy with embolization/surgery/radiotherapy. Deep venous drainage (p60 mm, venous dilatation present in the drainage vein (p60 mm, the angle of the casting feeding arteries in the nidus ≥130° and dilatation and/or venous aneurysm of drainage vessel are predictive for clinical presenting by hemorrhage

Application of the ommaya reservoir in the treatment of hydrocephalus in prematurely born children: Correlation with animal results

Introduction. Intraventricular hemorrhage occurs in almost one fifth of prematurely born children. Due to present complications, such as hydrocephalus and neurological deficit, it endangers the child’s life, therefore there is the need for understanding and prevent risk factors as well as the need for finding most optimal methods of treatment. Objective. The aim of the study was to point out the current therapeutic modalities of the treatment of posthemorrhagic hydrocephalus in prematurely born children. Methods. The study included 60 patients divided into two groups of 30 patients treated at the University Children’s Hospital of Belgrade in the period 2003-2008. Results. Treatment outcome of the control group of patients treated by standard methods was influenced by gestational age (p=0.024), head circumference on birth (p=0.043), body mass on birth (p=0.006), Apgar score on birth (p<0.001), peripartum asphyxia (p<0.001), cardiorespiratory arrest (p<0.001), respiratory distress (p=0.002) and intraventricular hemorrhagic grade (p<0.001). As statistically significant predictors of the poor treatment outcome of the experimental group of patients treated by using Ommaya reservoir were identified: low body mass on birth (p<0.05), low Apgar score (p<0.05), prolonged number of days on assisted ventilation (p<0.05), presence of peripartum asphyxia (p<0.05) and cardiorespiratory arrest (p<0.05). Conclusion. No statistically significant difference was detected in the outcome between the patients treated by the standard method and those with installed Ommaya reservoir. However, the difference of 10% in mortality between the two groups may be clinically significant so that further studies of larger samples are necessary